Lap band complications

Background

• laparoscopic adjustable gastric banding
• band placed at GE junction and inflated to limit food passage
• band constriction adjustable via reservoir
• subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention
• postoperative complications near 10% over lifetime of patient
• patients typically discharged same day or POD #1

Clinical Features

• abdominal, chest or neck/throat pain
• nausea, vomiting, food intolerance
• sepsis, abdnormal vitals

Differential Diagnosis

Early

At or near time of banding or adjustment of band

• Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
• Intra-abdominal bleeding
• Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea

Late

Weeks to years after adjustment or application

• Chronic Slippage
  • herniation of stomach through band
  • can occur long after surgery
  • may progress to gastric necrosis and perforation
• Gastric Erosion
  • Band can erode through the full thickness of the gastric wall 
  • can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis
• Port Complications
  • primary overlying skin infection may represent extension of intra-abdominal process
  • need abx coverage for intra-abd and skin flora
• Tubing Dislodgement
• Port Ulceration

Diagnosis

• Lab w/u dictated by presentation
• KUB-upright to assess band position & slippage
  • nl 30-45 deg to the horizontal (~2 o'clock)
• Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction
• CT AP to assess for perforation (contained or free), abscess, intra-abdominal fluid or bleeding
• Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion

Management

• early surgical consultation key for all patients suspected of having complications
• intra-abdominal sepsis EGDT, antibiotics
• remember to dose antibiotics for morbidly obese as neccesary
• if impending gastric necrosis due to edema/recent band inflation
• Can deflate band via port site, otherwise wait for surgeon

See Also

• Bariatric surgery complications
• Medical device complications

References

• Ann Emerg Med 2006;47:160-6